Utilization Review Nurse - Utilization Review

Utilization Review Nurse

Per Diem 1648 Huntingdon Pike Nursing RN/LPN Day SUMMARY OF JOB: To review each admission for appropriate assignment of level of care based upon clinical guidelines as well as to review documentation for continued stays daily and provide clinical information including assessments and outcomes for all payers and all levels of care as required by the payer. Work with physician advisor to better manage denials and downgrades. CONNECTING TO MISSION: All individuals, within the scope of their position are responsible to perform their job in light of the Mission & Values of the Health System. Regardless of position, every job contributes to the challenge of providing health care. There is an ongoing responsibility for ensuring that the values of Respect, Compassion, Justice, Hospitality, Holistic Approach, Stewardship and Collaboration are present in our interactions with one another and in the services we provide. RECRUITMENT and LICENSURE REQUIREMENTS: Registered Nurse: must have a current license in Pennsylvania from the Commonwealth of Pennsylvania, Department of State Bureau of Professional and Occupational Affairs. Bachelor degree preferred. Experience: Registered Nurse: a minimum of five or more years of acute care clinical nursing. Recent experience in a hospital, insurance company, or independent review company in utilization, quality review, homecare or case management Skills: * Thorough understanding of managed care systems and utilization review criteria * Working knowledge of managed care and third party reimbursement * Experience with case management, evaluation/assessment of clients * One hour of annual stroke education * Basic computer skills required Advocacy and problem solving skills * Excellent time management and strong written and verbal communication skills Possesses strong organizational and negotiation skills * Possesses strong team work skills * Strong organizational and prioritizing skills * Knowledge of community resources * Demonstrated leadership abilities Experience in the use of information systems EOE